Provider Demographics
NPI:1356576045
Name:SURCOUF, RENEE NOEMIE (LCSW)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:NOEMIE
Last Name:SURCOUF
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 APPLEBERRY DR
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-1208
Mailing Address - Country:US
Mailing Address - Phone:415-912-8987
Mailing Address - Fax:
Practice Address - Street 1:915 BRIDGEWAY
Practice Address - Street 2:
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965-3201
Practice Address - Country:US
Practice Address - Phone:415-912-8987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-25
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA222811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical